HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT .
ICOUNTY
Building & Code Regulations Division
• R 1 0 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner oft
hefollowing described property,
qdo lev Ce rPle7
(Parcel Id#/Legal description/Add ress) f 3 ` _ i si _ � —d c)0 3
for which I have applied to St. Lucie County for a Final Development Permit. In
Accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Pro er Name (Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _ DAY OF J 20�—
1/&r L Y� WHO IS PERSONAL KNOWN T ME (a OR WHO HAS
PRODUCED AS IDENTIFICATION.
�OSIGNATURE OF N ARY PUBLIC E OR PRINT NOTARY m�T
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
(SEAL)
Y�1;•,
AUCREYB.HUMPHREY
,•' fl_� ';a4
h'iY COMMISSION # FF 174772
EXPIRES: March 6, 2019
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